A Breast Surgeon's thoughts

A patient and family facing a diagnosis of cancer, are perhaps going through some of the scariest moments of their lives. They seek an oncologist’s knowledge and experience to help them sail through this rough time. The underlying assumption is that the oncologist will help them understand the disease and will plan a treatment that is in the best interest of the patient. Ideally this could be accomplished in a single visit “the first opinion.” After an initial opinion is sought however, patients and families often seek multiple “second opinions” prior to proceeding with treatment. Several reasons perhaps exist why second opinions are so commonly sought in oncology.

The stakes are high and one wants to make sure no mistakes are made where life and death is concerned.

You don’t have a “family oncologist” The oncologists are specialists you have likely never met before this diagnosis. Unlike with your family doctors, there is no ongoing trust relationship prior to diagnosis.

Second opinions are easily available. You hear multiple people recommending different doctors based on their experiences and even overheard information. Its easy to book multiple appointments with different oncologists even in same day.

The hope is that two oncologists would say the same thing, and reassure the patient of being on the right track. The “doctor shopping” experience however is seldom so easy. The multiplicity of opinions does not always make treatment choices easier. More often perhaps than not, the second opinion will be different from the first.

Some possible reasons why patients may hear different opinions about the very same case from different doctors may be

Oftenthere is really no “ one right answer” ; pros and cons of different approaches need to be weighed into making decisions. Often even best evidence and literature may not prove one approach to be better than another, and the oncologist has to simply pick one. In such cases different options may all still be safe and valid, even though they appear quite different from each other.

Oncologists practice in different eras. The expectation is all oncologists keep themselves updated with present-day best practices. Yet, there’s oncologists you may meet whose training periods may be separated by 30-40 years and some practice differences may be reflective of this time separation. There’s a ‘dogma generation’ and there’s a ‘data generation’ and they both believe they’re right.

Oncology is a business. The fact is oncologists want to keep their business running and want to “bring and keep the patient” under their care. Surgeons make money from operating, oncologists by giving chemotherapy and so on. The expectation is no one wants to give you a certain treatment simply to make money, yet sadly there’s plenty of leeway to conceal dubious intentions.

Just how many opinions a person seeks before he or she is satisfied varies greatly, yet there appear to be different styles and agendas to doctor shopping.

Finding the truth: An educated and well-informed section of patients, will seek to understand diseases and treatments in depth. They will often cross verify the doctor’s opinions with their own reading. They need doctors to satisfy all their queries until they feel ready to proceed.

Finding a fit: A specific gender of a doctor, A well-informed doctor who listens, a greying authoritative figure, may all be different doctor attributes that work for different people. Ultimately they seek opinions till they feel “this is my doctor”

Finding what you want to hear: In opinion shopping, one must learn to recognize this dangerous trait within oneself. It’s a pattern of shopping that may start with oncologists and may end with faith healers. There is always someone somewhere who will tell you just exactly what you want to hear, regardless of how ridiculous and …regardless of how wrong.

Finding someone to steer: Some patients find it very difficult to make choices in what is already a stressful time. They want to give up the driver seat to the treatment planners. After being offered choices by different doctors, they find security in someone who tells them exactly what to.

Finding a bargain: Oncological treatments can be an enormous economic burden. Insurance empanelment and variation of treatment charges between doctors or hospitals can greatly influence decisions. Convenience of location, conveyance and similar logistics may play a role in shopping until a bargain deal appears.

If conclusion, I’d say if you must shop doctors then shop informed, shop to seek the truths, shop till you find your own fit. Be aware of the dangers, don’t be hassled by contradictory opinions and don’t let the process delay treatments. At the end of the day, find someone you can trust..and then dotrust them ..or else the journey can be a lot more tiring than it needs to be.